To Cath or Not to Cath

Duke recently published a study examining if the number of cardiac catheterization procedures performed are justified. The study looked at patients who had no known coronary disease. The majority of the 400,000 patients in the study had a stress test prior to the diagnostic catheterization and most of the test results were “abnormal.”

The study found that 40 percent of the patients who went to the cath lab had no disease, 38 percent had significant disease and the remainder only had some disease. The study researchers concluded that catheterization may be an overused diagnostic tool in the United States.

We have similar statistics in our office. Two-thirds of the catheterizations that we do are normal or show a blockage so minor that it is too early to address the issues.

And, every day in our office for stress testing by treadmill or pharmacologic stress testing. These stress tests often involve some imaging modality such as nuclear imaging or echocardiogram. Often the stress tests do show a positive or “abnormal” result, which may show possible heart disease. However, abnormalities and severity vary widely. When patients and their family hear that there is an abnormality, they often want to know more – how bad is the blockage? Can it be removed, ballooned or stented?

Reducing the number of cardiac catheterizations is multi-faceted. First and foremost, we need more thoughtful interpretation of noninvasive stress tests. And, we need patients and physicians who are willing to work together to honestly discuss risk versus benefit and come to a joint conclusion. Lastly, we all need to live like we have heart disease. Eat well, exercise and take care of yourself – abnormal stress, clean catheterization or not.